With the United States on track to record its worst measles outbreak since the elimination of the vaccine-preventable disease almost 20 years ago, the role of a global, social media-driven anti-vax movement has again come under scrutiny.

There has been a global resurgence of the highly infectious measles virus in recent years, despite the rollout of a vaccine that saw the United States declare the disease eradicated in their country in the year 2000.

Source: WHO

Some two decades later, the US now finds itself in the grips of an outbreak set to be the worst on record since then, with officials in New York attempting to enforce a ban on unvaccinated children frequenting public places in a bid to stem infections.

Australia is experiencing a similar resurgence, with 83 cases reported already this year — comparable to the total number seen in all of 2017 and not far off the 103 recorded cases in 2018.

In response, Health Minister Greg Hunt this week announced a new awareness campaign aimed at bolstering vaccine coverage.

The CDC has confirmed nearly 100 more measles diagnoses since last week, pushing the 2019 case count closer to record levels less than halfway through the year https://t.co/HQWiXTADjK

I am concerned about the recent increases in measles cases in Australia and want to make sure our community is well protected against this very serious disease. Immunisation saves lives. Read more here – https://t.co/eUHR5l4Esv

Given the recent increase of measles cases being brought back toAustralia by travellers, the advice from the Chief Medical Officer is to check your measles vaccination status before travelling overseas. #vaccinationsavesliveshttps://t.co/IGKrZRE4QN

The global outbreak has stoked criticism of a growing global anti-vax movement blamed for the return of the illness, which continues to kill more than 100,000 people every year — largely among those under 5 years of age — and can cause pneumonia, encephalitis and blindness.

But are anti-vaxxers the full story? In an opinion piece cross-posted here with permission, epidemiologist Gideon Meyerowitz-Katz urges a more nuanced view of why people don’t vaccinate.

Gideon Meyerowitz-Katz writes:

Vaccines are a contentious topic. Partly that’s because we all have a very reasonable fear of being stuck with needles, and this often comes with the risk of Very Hot Takes On Twitter.

It’s also partly down to the fact that they are an incredible invention that has saved countless lives over the course of the last century.

Parents are an understandably fertile field on which to spread this deadly manure. Being suddenly responsible for another human life is a terrifying experience, and among the myriad decisions it can be easy to be misled by the loudest voices, even if they are medically untrained and wrong.

And with the resurgence of measles in countriesacrossthe globe, it’s becoming more and more clear that children just aren’t getting their vaccines any more. We’ve become complacent, convinced that, since many of us haven’t seen someone with measles in at least 4 decades, it’s not harmful.

Never mind that 100,000 people die each year from the disease. We’ve never seen it happen, so it won’t.

The easiest place to point our fingers is anti-vaccination activists. They are the ones, after all, who are spreading fear and mistrust. I’ve been guilty of this narrative myself — these activists are the loudest voices out there, and the screaming charlatan gets the grease*.

But it’s worth remembering that there are more elements to public health than a single group of people, and vaccination decision are no different.

Here are the top three reasons that children miss their vaccines. They might surprise you.

Poverty

The first thing on this list is a fairly common public health issue. If you want to be healthy, the first thing to do is be born rich. If you can’t manage that, being born white in a developed nation is the next best bet.

Whether it’s because health services are rare, because their parents work and can’t get them to the doctor, or simply because health services are often inaccessible to the people who need them most, kids who are less well-off are much more likely to miss their vaccines.

The biggest factor that contributed to the resurgence of #measles in recent years? Poverty. Medical systems in many countries remain too weak to vaccinate enough children year after year to wall out the virus, according to the @nytimes. https://t.co/boXPxCPzNr

Vaccine hesitancy

The last, and least surprising, reason that people don’t vaccinate is that they are worried that the vaccine will hurt their child. And I’m going to say something a bit controversial: their worry is justified.

But risks and benefits are hard to understand, and vaccination is a complex equation. Protecting your child is one thing, but the arguments about protecting society can be quite hard to understand.

There’s a whole field of research examining why parents get worried about vaccines and how to reassure them.

The problem is, on the side of science you’ve got complexity, but on the side of charlatanry you’ve got certainty. They might be completely wrong, but anti-vaccine activists sound like they know what they’re talking about.

So yes, parents’ worry is justified. They have unscrupulous quacks belting out nonsense doing their best to cover over the fact that decades of research proves vaccines safe.

Get vaccinated

Ultimately, there are many reasons children miss their shots. Sometimes it’s because of anti-vaccine activists, but often it’s down to social issues that are in many ways harder to combat.

We can promote vaccines in any number of ways, but it’s often much harder to change society. Reaching at-risk groups with vaccines can be much harder than persuading rich people that the local all-natural life coach purchased their degree for $10 from an online “university” and doesn’t actually know what they’re talking about.

Protecting society against infectious diseases is a long, hard slog, and it’s worth remembering that anti-vaccine activists aren’t the only problem.

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